PSA following ADT and RT

[Pcsurvival89]

Hello everyone,

This is about my father, who got diagnosed with Pca around last june'21. The details of his journey so far is in my bio, but I will keep it short here. He was diagnosed with a gleason 8 adenocarcinoma with local spread to the lymph nodes, EPE+, right SVI+, psa 308.

Following initial diagnosis, he was started on Firmagon.

4/5 months after that, we had a psma pet scan done that showed :Ca prostate with mild residual mass lesion in relation to base and mid gland region. Enlarged PSMA avid bilateral external iliac lymphnodes that have also shown significant interval reduction in size. Subcentimeter sized PSMA avid left paratracheal, left supraclavicular lymph nodes. No evidence of PSMA avid lytic or sclerotic lesion.

Our oncologist decided to treat him with IGRT(prostate and pelvic LN), 6600cgy/28#.

It has been 3 months since my father completed his radiation and we got a psa done. His psa is 1.4 now. I must mention that the last time we checked was nearly 4 months back , prior to starting radiation and it was 2.88.

Our oncologist now says that she wants to do a psma pet scan as the drop in PSA isn't satisfactory and it should have plummeted to undetectable /lower considering he had both radiation done and is on ADT.

I must say that I am a little bit worried after this conversation with his RO. Maybe the ADT has stopped working? I was also wondering how fast or slow the PSA fell for those of you who had ADT+RT.

I want to thank everyone in advance as this group has been a source of immense support over the last couple of months.

[Tall_Allen]

Maybe ask for an FDG scan. Better yet, if any of the new mets are large enough, biopsy it for histology and IHC. He may have some PCa that is unresponsive to hormone therapy.

[SteveTheJ]

Listen to the doctor. I believe any PSA less than 0.5 is good but 1.4 might not be that high. However, I'm just another patient, not a doctor. Others here might be able to shed more light.

Don't give up hope though, that's for sure.

[timotur]

In most cases, nadir after radiation is 12-18 months. Since your Dad still appears to be M0, but has LN and SV involvement, I would ask an RO about HDR Brachy. I had the same pathology, though not as extensive, and took that route (in profile). He should get the PSMA scan nevertheless. If it shows spots in the prostate and SV, definitely pursue HDR-BT for that area.